A prospective study on the reliability and cost effectiveness of preoperative ultrasound screening of the "marginal" liver donor.

With the growing shortage of available liver donors, many donors with risk factors that would have traditionally precluded liver procurement are now being considered. In this prospective study, we evaluated 50 "marginal" liver donors with pre-procurement abdominal ultrasounds and correlated results with findings at procurement and with subsequent allograft function. The results show that the ultrasounds have a specificity of 96% and a sensitivity of 68% in predicting abnormalities in donor livers that precluded transplantation. In addition, using ultrasound to screen marginal donors would result in significant savings in manpower and hospital resource utilization without "missing" any normal liver organs. Our results also show that, when properly selected, livers from donors with one or more high-risk factors function well with acceptable primary nonfunction rates.

Tuberculosis and alcoholism. A partial solution through detection.

Alcoholism and tuberculosis often coexist, and patients with this combination have the most frequent failures of therapy. Several intriguing alternatives to standard outpatient chemotherapy are now available. The brief MAST interview (a shortened version of the Michigan Alcoholism Screening Test) has been demonstrated to be effective in identifying alcoholism in public health clinics for tuberculosis in New Orleans and Birmingham, Ala., with scores indicating populations of alcoholic patients of 25% and 28%, respectively. The test could be administered without interrupting the routine of the clinic. We believe that the problem of inadequate therapy in the alcoholic patient with tuberculosis is significant and widespread and is not being handled well is most places. Identification of the potential problem patient at first contact will be most helpful in choosing candidates for specialized forms of therapy, including short-term and supervised treatment, begun before failure of therapy ensues.

Chest radiographs during isoniazid therapy.

For most tuberculin reactors, chest radiographs are obtained at the beginning of, at various intervals through the course of, and at the end of the year of isoniazid preventive therapy. A study of 1,524 tuberculin reactors was performed to determine the value of chest radiographs obtained after therapy was begun; 1,315 had normal radiographs at the beginning and end of therapy, and 209 had radiographic abnormalities at both times. No significant changes were noted in any of the 1,524 patients' radiographs. Similar results had been reported for 551 tuberculin reactors in an earlier study. This provides a total of 2,075 patients for whom no value could be found in the subsequent radiographs. We found no value in repeating normal chest radiographs of positive reactors if they had completed at least 9 months of the properly recommended 12 months of isoniazid preventive therapy. The lack of value of repeat radiographs, coupled with their fixed cost and the potential risk of unnecessary radiation, dictated our change in policy--we no longer repeat normal chest radiographs in such persons.

Lymphocytic choriomeningitis from pet hamster exposure: a local public health experience.

Eleven cases of hamster associated lymphocytic choriomeningitis occurred within a space of four months in Jefferson County, Alabama residents. A single Birmingham breeder was the source of the infected hamsters. Ten cases experienced an illness of one to three weeks duration with grippe-like symptoms being most frequent. Complaints of nine cases suggested meningeal involvement, and one was asymptomatic. All patients recovered uneventfully. Frequent hamster contact had occurred in most cases, although three individuals reported infrequent or room exposure to the animals. The holding of hamsters for observation prior to sale, random testing of all breeders' stock, and the distribution of printed information with each hamster sold are suggested as precautions against future outbreaks of this nature.